This surgery includes cutting and realigning the femur. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. See also: retroversion and Tomczak et al. Several factors, including obesity and a decreased femoral anteversion angle, have been associated with the development of slipped capital femoral epiphysis (SCFE) [31]. An excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Differences in femoral torsion among various measurement methods increase in hips with excessive femoral torsion. 5 Femoral version, also referred to as femoral torsion, is another morphologic variable being investigated. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Unlike in- toeing, out-toeing may lead to pain and disability as the child grows into adulthood. The prevalence of femoral retroversion was high in our study and ranged from 47% to 91%, depending on the applied measurement method (Table 3). Abduction of the forefoot associated with pes planovalgus. Surgical treatment of symptomatic post-slipped capital femoral epiphysis deformity: a comparative study between hip arthroscopy and surgical hip dislocation with or without intertrochanteric osteotomy. [44] (Table 4). Furthermore, the reliability and reproducibility of these measurements in patients with SCFE is unknown. A subset of patients was measured twice by two readers (FS, JRK) to assess intraobserver reproducibility and interobserver reliability. It is also known as 'Trochanteric Prominence Angle Test (TPAT)'. Causes of the Anteversion and Retroversion of the Hip Bone Joint J. The condition is usually congenital, meaning children are born with it. Clin Orthop Relat Res. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. The mean femoral neck version was lower on the SCFE side than on the contralateral side (-2 13 versus 7 11; p < 0.001) (Table 3). Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. Slipped capital femoral epiphysis: prevalence, pathogenesis, and natural history. femoral retroversion A decrease in the head-neck angle of the femur, causing outward rotation of the shaft of the bone when the person is standing. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? 1993;75:1141-1147. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. These differences ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on Tomczak et al.s [44] method to -22 13 (95% CI -25 to -19; p < 0.001) when applying Murphy et al.s [30] method (Fig. Erickson JB, Samora WP, Klingele KE. 2020;14:98-105. Thus, we compared femoral version angles and the prevalence of femoral retroversion in hips with SCFE with the unaffected contralateral side and among different measurement techniques. 2017;21:487-506. When comparing hips with SCFE with the unaffected contralateral side, we found higher differences (range of mean differences -22 to -17) with measurements that consider the femoral heads center than for the method of femoral neck version (mean difference -8) (Fig. New York, NY 10021 is femoral anteversion a disability. The effects of simulated microgravity on the static and dynamic properties of large arteries are still mostly unknown. In some cases, a minimally invasive version of a femoral osteotomy may be performed. 519 East 72nd St., Suite 204 Many children born with femoral retroversion grow out of it. From proximal to distal, this included the most-proximal methods (Lee et al. to call, please leave a message and we will return your call. official website and that any information you provide is encrypted If you prefer Results: J Bone Joint Surg Am. (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? 2017;6:472-480. External rotation contracture of the hip. Femoral retroversion is common in newborns because of contracture of the hip from intrauterine positioning. [30]), and the corresponding prevalence of femoral retroversion were compared between hips with SCFE and the unaffected contralateral side. Initial diagnosis of unilateral SCFE was based on an absence of radiographic signs of SCFE and of pain at clinical examination. The greatest differences were between measurement methods that are based on the most-proximal landmarks and those based on the more-distal landmarks. J Bone Joint Surg Am. Accordingly, differences in femoral version angles between proximal and distal measurement methods were as high as -19 (Table 4). Increased BMI leads to an increase in simulated loads across the physis [33] and may be further aggravated by retroversion of the femoral neck, which has been associated with obesity [14]. Conclusion: 26. These differences between hips with SCFE and the contralateral side were higher and ranged from -17 11 (95% CI -20 to -15; p < 0.001) based on the method of Tomczak et al. Schmaranzer F, Meier MK, Lerch TD, Hecker A, Steppacher SD, Novais EN, Kiapour AM. The aim of the current study was to obtain precise normal values of the femoral anteversion angle using computed tomography on cadavers of mature dogs with normal hip joints of . Bali NS, Harrison JO, Bache CE. We compared femoral version angles and the prevalence of femoral retroversion among all five measurement methods. Any treatment of my symptoms was going to be ineffective due to the alignment still being off. Out-toeing is the common name used for a condition known as femoral retroversion. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. Slipped capital femoral epiphysis. Bone Joint Res. They reported femoral neck angles of -0.7 7.4 in 13 patients (10 with obesity) with acute SCFE compared with angles of 6.3 8.2 in the uninvolved side [15]. To date, the best treatment strategy in patients with symptomatic SCFE deformity is not known because of a lack of comparative studies with long-term follow-up [2, 47]. The effect of modality and landmark selection on MRI and CT femoral torsion angles. Bali K, Railton P, Kiefer GN, Powell JN. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. Bone Joint J. 23. Since the range of femoral version angles is wide, no general prediction regarding the degree of rotational deformity can be made on an individual basis. Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. [] reported an association of SCFE and femoral retroversion.More recently, many studies have shown an association . Femoral antetorsion was significantly higher in patients with pincer-type FAI than in those with cam-type FAI for reader 1 (18.3 9.8 vs 10.0 9.1, P = .02) and reader 2 (18.7 10.5 vs 11.6 8.8, P = .04). Clinical data is missing for assessment of clinical and radiological outcome, as well as complications. Although external rotation of the proximal femur relative to the femoral condyles (that is, femoral retroversion) has been linked with the onset of SCFE and has been proposed to result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in SCFE [24, 31]. However, among the remaining measurement methods, it is not possible to recommend one measurement method over another based on our findings. This could theoretically affect anatomic landmark selection for femoral version measurements and corresponding femoral version angles. 212-606-1415, About Limb Lengthening & Deformity Correction, Bone Tumors: Symptoms, Treatments and Outcomes, Femoral Anteversion: Causes, Symptoms and Treatment, Femoral Retroversion: Causes, Symptoms and Treatments. Morphologic Features of the Contralateral Femur in Patients With Unilateral Slipped Capital Femoral Epiphysis Resembles Mild Slip Deformity: A Matched Cohort Study. 39. where does bone formation occur during endochondral ossification? Symptoms of femoral retroversion may include: If the doctor suspects a femoral retroversion, he will conduct a physical examination of the legs and hips in addition to a thorough medical, developmental and family history. Novais EN, Millis MB. At the time of CT, the femoral growth plate of the asymptomatic contralateral side was already closed in 42% (33 of 79) of patients. Coxa vara. However, an excessive femoral retroversion can place stress on hip and knee joints, often leading to joint pain and abnormal wear. Background: 2018;38(suppl 1):S5-S12. The retroversion was causing a minor curvature in my lumbar spine, tendinosis in my hamstring, and labral tears. J Child Orthop. Case reports: acetabular damage after mild slipped capital femoral epiphysis. Millis MB. 2019:47:3120-3132. Madhuri V, Arora SK, Dutt V. Slipped capital femoral epiphysis associated with vitamin D deficiency: a series of 15 cases. Arthroscopy. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. [19] method -19 16 [95% CI -25 to -12] versus -19 16 [95% CI -23 to -15]; p = 0.90, respectively) (Table 5). Combined Imhauser osteotomy and osteochondroplasty in slipped capital femoral epiphysis through surgical hip dislocation approach. Intraclass correlations: uses in assessing rater reliability. These differences increased when including the femoral heads center as a reference. J Pediatr Orthop B. Also called hip anteversion, femoral anteversion refers to a forward (inward) rotation in the femur (thigh bone and knee) which connects to the pelvis to form the hip joint. One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. VDK is a continuous series of pathological changes from the lightest to the most severe degrees. 10. Disclaimer, National Library of Medicine 2014;96:1441-1448. may email you for journal alerts and information, but is committed 2016;98:21-27. Basheer SZ, Cooper AP, Maheshwari R, Balakumar B, Madan S. Arthroscopic treatment of femoroacetabular impingement following slipped capital femoral epiphysis. Reduced femoral neck version is more common in adolescents with obesity than in those without obesity [14]. your express consent. 1999;81:1747-1770. Int Orthop. During the period in question, the general indication for obtaining a CT scan in this context was to assess the severity of the deformity to define the surgical strategy. Femoral neck version was measured as the orientation of the femoral neck. Purpose. During this time period, 754 patients were diagnosed with SCFE. AR is associated with changes in load transmission across the hip, being a risk factor for early. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. Excessive femoral anteversion can cause instability, damage of the articular cartilage and acetabular labrum, and eventually osteoarthritis. Limb Lengthening and Complex Reconstruction Service Lerch TD, Boschung A, Todorski IAS, et al. Baraka MM, Hefny HM, Thakeb MF, et al. The condition is somewhat more common in girls than boys. J Bone Joint Surg Am. 1987;5:523-528. Varus derotation intertrochanteric osteotomy with femoral retroversion. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. [35]; range, -53 to 15) to 100 (Murphy et al. Femorln retroverze. (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? In addition, we observed increasing femoral version angles with selection of more-distal landmarks in SCFE hips regardless of whether or not previous in situ pinning had been performed (Table 5). She was treated with an open reduction and bracing in infancy. An important mark of this deformity is the reduced or absent offset between the femoral head and the neck, which can be radiographically graded. In anatomy, the word version refers to the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. Obesity and decreased femoral anteversion in adolescence. This underlines the complex, multifactorial pathogenesis of SCFE, which further includes endocrine disorders [26] and altered epiphyseal orientation [24] and morphology [17, 23] and warrants further investigation. Southwick WO. Shrout PE, Fleiss JL. In anatomy, the word version refers to the angle or rotation of all or part of an organ, bone or other structure in the body, relative to other structures in the body. (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? The condition is usually congenital, meaning children are born with it. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Also called hip anteversion, femoral anteversion is a forward (inward) rotation in the femur (thighbone), which connects to the pelvis to form the hip joint. [44]: 0 13 and Murphy et al. 32. However, in some cases, this may be difficult to identify, especially if femoral retroversion is combined with a separate rotation deformity such as tibial torsion. Fourth, although we compared our observations in SCFE hips with the unaffected contralateral side, we note that these hips may not reflect a normal population. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. 27. The mean age at the time of CT was 15 4 years. The vessel traverses the thigh and takes a superficial course at the femoral triangle before passing beneath the inguinal ligament into the pelvis as the external iliac vein (figure 1A-B). Questions/purposes: This condition can affect patients of all ages and leads to abnormal stress in the low back, hip and knee and abnormal gait. A subset of patients was measured twice by the first obsever as well as by a second orthopaedic resident (JRK, 2 years of experience) to assess intraobserver reproducibility and interobserver reliability. The hip joint is where the femoral head (the top of the femur) meets the pelvis. In patients with implant failure following in situ fixation, this included assessment of the femoral growth plate for planning of revision in situ fixation. J Pediatr Orthop. 479(5):960-961, May 2021. As mentioned, measurement of femoral version in children with SCFE should include the femoral heads center as a proximal reference axis; that is, it should not be solely based on the orientation of the femoral neck. In many cases, the child may grow out of it. 2023; 12(3):751. https: . Top-view illustrations of excessive femoral retroversion. J Child Orthop. and Murphy et al.). For both the SCFE side and contralateral side, we found an increasing prevalence of femoral retroversion when the more-proximal landmarks were selected (Table 3). 2012;28:965-971. The most significant clinical implication of femoral retroversion is that it is not soft tissue-related. To rule out any subsequent SCFE of the contralateral hip, we further assessed the status of the femoral growth plate at the time of CT and at latest follow-up. What are the causes of femoral retroversion? Level III, prognostic study. Radiology. Balakumar B, Flatt E, Madan S. Moderate and severe SCFE (slipped capital femoral epiphysis) arthroscopic osteoplasty vs open neck osteotomy-a retrospective analysis of results. Femoral neck version, the femoral version angles based on the measurement methods that include the femoral heads center (the methods of Lee et al. the axis of the femoral neck is oriented more posteriorly than the distal reference line connecting the dorsal border of the femoral condyles. The method of Reikers et al. The mean age was 15 4 years, 48% (38 of 79) of the patients were male, and 56% (44 of 79) were obese (defined as a BMI > 95th percentile (mean BMI 34 9 kg/m2). 41. 28. All CT scans including axial images covering the osseous pelvis and distal femoral condyles were used to measure femoral version. Using the method of Murphy et al. My doctors would not treat me unless I had surgery to fix the retroversion. Bookshelf In hips with SCFE, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility for reader 1 (ICC range 0.93 to 0.96), for reader 2 (ICC range 0.97 to 0.99), and interobserver reliability (ICC range 0.95 to 0.98) for all five measurement methods (Table 6). Seventy-two percent of the patients in our cohort were overweight or obese. 45. 9. After applying prespecified inclusion and exclusion criteria, we included 79 patients. Journal of Clinical Medicine. After applying prespecified inclusion and exclusion criteria, we included 79 patients. In some cases, hip/femoral retroversion may be combined with a separate torsional deformity, such as a rotation in the tibia. Schmaranzer F, Todorski IAS, Lerch TD, Schwab J, Cullmann-Bastian J, Tannast M. Intra-articular lesions: imaging and surgical correlation. The femur bone is cut through a portal and an intramedullary rod is inserted into the marrow cavity of the bone. For the definition of femoral neck version, the midpoint of the femoral neck axis is determined at the level where the cortices run parallel and serves as the proximal reference axis (Fig. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. Femoral retroversion is often a congenital condition, meaning it is present from birth and develops in the womb. Wylie JD, Beckmann JT, Maak TG, Aoki SK. 2020;14:190-200. Clinical features include an abnormal gait and pain with prolonged weight-bearing. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods on femoral version angles has yet to be studied in SCFE. A labral tear, subspine and intertrochanteric impingement and femoral retroversion. Please enable it to take advantage of the complete set of features! If a thickened medial plica is suspected, this can be palpated over the medial femoral condyle with the knee at 30. Femoral retroversion is a positional deformity caused by contracture of the external rotator muscles of the hip. Osteotomy to correct the alignment is rarely needed. The epidemiology of bilateral slipped capital femoral epiphysis. Three-dimensional CT was performed with all patients supine in the neutral position. 2019;37:1571-1579. 2. More specifically, the prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. Femoral retroversion often runs in families, which may indicate that some children have a higher risk of being born with this condition. Hip dysplasia. The first symptom of femoral retroversion is usually a visual recognition of the rotated femur. Among these, the greatest differences were between the most-proximal methods and the more-distal methods. Femoral neck version was measured as the orientation of the femoral neck. If the individual also has a separate rotational bone deformity such as internal tibial torsion an inward rotation of the tibia (shinbone) then femoral retroversion becomes even more difficult to diagnose. How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Bone Joint J. [19], Reikers et al. The source of all of my pain was the retroversion of my femur. femoral retroversion (___ degrees), femoral retroversion (physical finding), femoral retroversion, Femoral retroversion. The prevalence of femoral retroversion was high in patients with SCFE, and even higher when retroversion was defined and diagnosed using proximal anatomic landmarks. Femoroacetabular impingement patients with decreased femoral version have different impingement locations and intra- and extraarticular anterior subspine FAI on 3D-CT-based impingement simulation: implications for hip arthroscopy. Articles in PubMed by Florian Schmaranzer, MD, PhD, Articles in Google Scholar by Florian Schmaranzer, MD, PhD, Other articles in this journal by Florian Schmaranzer, MD, PhD, May 2021: Selected Proceedings from the 2020 Bernese Hip Symposium, Privacy Policy (Updated December 15, 2022), Overweight (% between the 85th and 95th percentiles), Duration of symptoms at initial diagnosis, Flexion-derotation intertrochanteric osteotomy, Anatomic landmark to define the proximal reference axis, A line is drawn that connects the femoral heads center with the most cephalic junction of the greater trochanter to the femoral neck, A line is drawn that connects the center of the femoral head with the center of the femoral neck at the level where the anterior and posterior cortices run parallel, The center of the femoral neck at the level where the anterior and posterior cortices run parallel, A line is drawn that connects the femoral heads center with the center of the greater trochanter at the base of the femoral neck, A line is drawn that connects the femoral heads center with the base of the femoral neck superior to the lesser trochanter, Femoral version measurements (), hips with SCFE, Femoral version measurements (), contralateral hips. Thus, the hip possesses three degrees of freedom of motion with three correspondingly arranged, mutually . Second, we did not compare femoral version between different severity grades of SCFE because most patients had a severe slip. Background: Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. Depending on the measurement method, femoral version angles vary considerably in hips with high femoral anteversion [37]. 1956;88:3-41. Among 10 possible pairwise combinations, we detected differences for 8 pairwise comparisons in hips with SCFE (Table 4). Femoral retroversion can result in the crushing of the labrum. Koerner JD, Patel NM, Yoon RS, Sirkin MS, Reilly MC, Liporace FA. Bone Jt Open. Mechanical risk factors for SCFE include rapid growth spurts, femoral retroversion, and femoral neck shaft angle. 1987;69:1169-1176. 3). 13. [1] Femoral anteversion is the angle between the femoral neck and femoral shaft, indicating the degree of torsion of the femur. Twenty-nine percent (23 of 79) of patients had no previous surgical treatment for SCFE. A subset of patients was measured twice by the first observer and by a second orthopaedic resident (2 years of experience) to assess intraobserver reproducibility and interobserver reliability; for this assessment, we used intraclass correlation coefficients. 8600 Rockville Pike To develop effective prevention strategies, we must first understand what it is, what impact it . Limb Lengthening and Complex Reconstruction Service, out-toeing or "duck walk" walking with the foot pointed outward instead of straight ahead. J Orthop Trauma. Sucato DJ. In the axial HASTE images over the proximal and distal femur a femoral retroversion can be seen, i.e. (2) These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles. Future studies should compare femoral version in SCFE hips to age-matched volunteers without a history of hip disease. Proximal femoral physis shear in slipped capital femoral epiphysis--a finite element study. Left: Position of a retroverted femoral head with the foot facing straight forward. We detected mean differences ranging from -19 to 4 (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility (reader 1, range 0.91 to 0.96) and interobserver reliability (range 0.89 to 0.98) for all five measurement methods in healthy contralateral hips. External tibial torsion. Southwick WO. All measurement methods are based on true axial images and a line connecting the femoral condyles as the distal reference axis. We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral heads center. 2017;11:93-98. 3). 8. However, future studies are needed to investigate the value of different measurement methods in predicting the surgical outcome in patients with SCFE undergoing different procedures. Tnnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). and Tomczak et al. In our study, the prevalence of femoral retroversion was higher (60%) in hips with SCFE and the mean femoral version was decreased (-4 16) using the same method described by Murphy et al. The right leg is 1.5 cm longer than normal. Femoral version of the general population: does normal vary by gender or ethnicity? Montgomery AA, Graham A, Evans PH, Fahey T. Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. J Bone Joint Surg Am. The opposite condition, in which the femur has an abnormal forward (inward) rotation, is called femoral anteversion. The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. Thus, this should not jeopardize the results of our study to a relevant degree. Fifty-one percent (40 of 79) of patients presented with severe SCFE based on the head-shaft angle described by Southwick [40] (< 30 mild, 30 to 60 moderate, and > 60 severe) measured on preoperative frog-leg lateral views. For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan. Retroversion refers to an abnormal backward rotation of the hip relative to the knee. This condition is diagnosed in childhood, and is characterized by the unusual "duck feet" posture and walk that the child develops. The normal angle of neck of the femur and the transverse angle of the femoral condyles is 8-12 degrees anterior in the average adult. Following exclusion of a total of 36% (44 patients), the final cohort consisted of 79 patients (Table 1). We performed a subgroup analysis, and with the numbers available, we observed any differences in femoral version angles between patients with and without previous in situ fixation (Table 5). 2019 May;477(5):1073-1083. doi: 10.1097/CORR.0000000000000610. Paired t-tests including Bonferroni corrections for repeated measurements were performed for comparison between the mean femoral version angles. J Pediatr Orthop. Among these, the greatest differences were between the most-proximal methods and the more-distal methods, with a mean difference of -19 7 (95% CI -21 to -18; p < 0.001), comparing the methods of Lee et al. Loder RT, Aronson DD, Greenfield ML. Diagnosing femoral retroversion can sometimes be difficult, as the common positioning used for X-ray imaging may not reveal a rotation in the femoral neck. 1988;8:385-388. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. Therefore, quantifying femoral version in patients with SCFE should be based on a measurement technique that includes the femoral rotations center. Femoral Retroversion. Conclusion Femoral antetorsion can be measured rapidly and with good reproducibility with MR imaging. We reviewed our institutional database for patients who were treated for SCFE and had undergone pelvic CT scanning for surgical planning. The prevalence of femoral retroversion (< 0) was compared using a chi-square test. The overall mean femoral version angles increased for hips with SCFE (range of means -19 to 0) and the contralateral side (range of means 2 to 19) using distal landmarks compared with more proximal landmarks (Fig.
is femoral retroversion a disability